By Joseph J. Massad, DDS
Let’s start by reviewing some common complaints from the patient’s perspective when they experience a variety of negative issues with their newly placed restorations. These include: inability to chew well; the teeth are not centered to the face; when smiling, too much gum is displayed or the teeth may appear too large or too small, or there is an uneven show of teeth. In cases like these, dentists may feel embarrassed or rejected and frequently respond by trying to divert the blame elsewhere. Let’s face it – no one feels good being criticized.
Generally, the patient directs blame on the dentist. To save face, the dentist may blame the lab. Then the laboratory technician may respond by blaming the dentist and stating that everything fit the model and inadequate information was provided to get the desired result. The treating dentist, in the end, is alone held responsible by the patient. What can we do to avoid situations like this and avoid a negative outcome? Rather than playing the blame game, let me outline a protocol that has been successful in my practice for the last 35 years.
First of all, the responsibility of the dentist from the onset is to attempt to satisfy all patients by providing a thorough evaluation and having a straightforward discussion to determine their level of expectation. Such conversations involving cosmetic variables must occur before agreeing to perform definitive treatment on patients. Dentists can avoid many of these potential problematic occurrences with photographic documentation of the patient’s facial display, including profile and frontal views while at rest, light smiling, and vigorous smiling, to determine the pretreatment existing relationships.
Requiring patients to view the pretreatment photographs allows codiscovery and a trusting discussion concerning what can and cannot be accomplished with dental prosthetics. This information can determine whether a prosthesis alone can alter the inherent facial asymmetry to satisfy the patient’s expectations. As an example, visual perception of tooth midlines is generally in the eye of the beholder, which is influenced by personal feelings, tastes, or opinions. A dentist can always opt to not treat. However, reasonable patients can be treated with predictable success as long as both parties are on the same page and mutually agree.
Avoidance dentistry teaches practitioners to educate patients before treatment that there are variable differences in what people perceive to be esthetically pleasing. Allow patients to make the final decision before final prosthetic delivery. Once this has been established, the dentist can then have the patient sign a form indicating that they are accepting certain cosmetic variables. The dentist, in this case, is now transferring the responsibility back to the patient.
When it comes to the prosthetic laboratory, dentists need to communicate face to face with technicians to discuss challenging cases. With today’s technology, this can be easily accomplished by computer-to-computer video conferencing. In our office, we use Skype and FaceTime to communicate with our technicians on a daily basis. It is very easy not only to discuss cases with the technician, but also both the technician and the dentist can view the actual models along with photos to develop the final prosthetic design. I have found this to be one of the best ways of communicating with my laboratory on a daily basis. Even with detailed written work authorizations, instructions can be confusing and items left out.
The clarity of computer-to-computer video conferencing generally will depend upon your internet connection. However, the communication can be so clear that you feel as if you are sitting next to your technician in the lab. In order for us to utilize this as a tool in communicating with our prosthetic technicians, consider purchasing a camera that is not built in to your computer so you can move it easily to focus on any angle or magnification of whatever you need to communicate in making a treatment decision. This communication technology is very reasonable in cost, and in my case I justified the cost in a single patient case.
In conclusion, a thorough evaluation including photographic documentation and an open, honest discussion of what can and cannot be accomplished in conjunction with a close partnership with your prosthetic technician can be your biggest edge to consistent successful prosthetic treatment outcomes.
Dr. Joe Massad may be reached by phone at 918-749-5600 or by email at [email protected].